Getting To Medical Freedom

An interviewer once asked H.L. Mencken, “If you find so much that is unworthy of reverence in the United States, then why do you live here?” Mencken quickly responded, “Why do men go to zoos?”

It is for the same reason that I find myself continually watching political debates.

Many questions seem so incredibly simple to answer, yet politicians divert from yes-or-no answers to complex, unrelated explanations about how patriotic the candidate really is. I frequently try to place myself onstage and wonder how I’d answer questions if given 30 or 60 seconds.

The topic of healthcare especially bugs me, and questions about how to fix it can certainly be answered in 60 seconds, although not explained so quickly.

To improve medicine in the United States, we’ll first need to explain that we are far from a free market in healthcare.

Of all government interferences in healthcare, one of the most insidious is the state’s granted privilege to the American Medical Association.

Through various attempts to portray homeopaths as uneducated witch doctors, the AMA has managed to get its preferred, allopathic form of medicine enforced by a legal monopoly. And as recently as the 1980s, the AMA attempted to prohibit voluntary associations between its member physicians and chiropractors, who were deemed participants in an “unscientific cult” (PDF).

The AMA’s main interest isn’t the safety of the American population; its main interest, like any union, is to increase the salaries and conditions of its members — medical practitioners.

Warning for decades of a surplus of physicians, the AMA is basically letting consumers know that their healthcare bills would be much lower if there were a greater supply doctors to address patient demand. Yet the organization has been successful in avoiding this hazard, with the average doctor now maintaining a patient list of at least 2,000 people.

The AMA’s Council on Medical Education has limited and shut down medical schools, increasing the barriers to entry in the field. Dale Steinreich writes,

Since AMA’s creation of the Council a century ago, the U.S. population (75 million in 1900, 288 million in 2002) has increased in size by 284%, yet the number of medical schools has declined by 26% to 123. In terms of admissions limits, the peak year for applicants at U.S. schools was 1996 at 47,000 applications with a limit of 16,500 accepted. This works out to roughly 64% of applications rejected. On a micro level, for the last six years the University of Alabama (hardly a beacon of prestige in the medical discipline) has averaged about 1,498 applicants per year with an average of about 194 accepted. This is about an 87% rejection rate. The sizes of the entering classes have been of course even smaller, averaging about 161.

It is almost impossible to imagine that every single student rejected from these medical schools was so incompetent that his mere existence in the medical market would have wreaked havoc on American healthcare. When a fiercely limited supply is coupled with third-party payments, it is no wonder that the healthcare system in the United States is absolutely disastrous.

The common opinion is that our country needs the AMA to protect us from unskilled physicians and surgeons. But this fails to consider the possibility that the AMA’s licensing process might not be the best option. If it were, patients would voluntarily ensure that their physicians were licensed by the association; after all, who cares more about an individual’s body than the individual himself?

For one reason or another, I am quite prone to strep throat; and, this being a phenomenon I’ve experienced since childhood, I can easily self-diagnose. I can recognize the symptoms, and I know exactly which dose of medicine my body requires, yet the government insists that its bureaucrats understand my health better than I do.

Instead of just walking to the nearest convenient store to purchase the 875mg tablets of amoxicillin, I’m forced to take a visit to my state-licensed physician for a 10-minute appointment (usually 1 minute spent diagnosing my strep throat and 9 minutes spent diagnosing my bill), drive to the nearest convenience store to deliver my prescription to a state-licensed pharmacist, and take the antibiotic, while my now-mandated insurance skyrockets.

Getting rid of the state privileges of the AMA is the first battle we need to fight in reaching a freer and more prosperous market in healthcare. The AMA will still exist for those who wish to employ its members, but stripping down licensure legislation will guarantee other options for those of us who are weary of current medical education and its subsequent practice.

13 Responses to “Getting To Medical Freedom”

Call me pessimistic, but I really don’t see the AMA losing its monopoly until the state dies. On the flip side, I’d love to see agorist doctors practicing medicine without permission. That’s the only way I think it will happen. Dangerous, yes. But is practicing medicine without permission any more dangerous than selling drugs? Where there is a will there is a way.

Great article. The general solution to the healthcare crisis in this country could be stated thus: Legalize all drugs and voluntary medical transactions. It’s a simple, elegant solution that would be vastly cheaper and much more humane than the one we have, not to mention the fact that it would be consistent with the ideal of freedom that the establishment commentariat supposedly cherishes but always fights against.

Yeah right. It’s not hard to see how much quackery fills up the “alternative” groups. Good riddance to those who can’t hack it. Such Libertarian whining is all about incompetent hacks who aren’t either capable of being a professional or aren’t willing to put in the hard yards.

Prior to 1938, if you got sick, you could go to your local drug store and tell the druggist how you were. Usually the druggist, drawing on his experience, could sell you something to deal with your sickness. Or if it was beyond his abilities, refer you to a doctor whom he knew and trusted. Obviously this sort of policy saved people money, something important at the time due to the Great Depression. However the doctors were “hurting” because every time someone went to the drug store and got help, that meant a doctor didn’t get his fee. So the doctors, acting through the AMA along with the help of the FDA, got the Roosevelt administration to pass prescription laws which required a doctor’s prescription for almost any medicine. The druggist got his fee for filling the prescription, the doctor got his fee for seeing the patient, and the only “loser” in this was the person who now had to pay much more for his or her medicine than before. As a member of the Libertarian Party I have been pushing for repeal of prescription laws for years now. Simply repealing these laws would allow many people to be able to take care of their own health without involving profit seeking doctors and the even yet more profit seeking insurance companies who take your money in premiums, but only return 80 to 85% of what you paid in to them in the form of benefits. Additionally, since prescriptions expire, if you are taking medicine for any chronic condition, you end up paying for additional doctor visits because once the doctor has his or her “hold” over you, they can demand office visits every few months or they will refuse to renew your prescriptions. The legal term for this is “extortion”, but have you ever heard of a doctor being prosecuted for it? Too, the insurance companies are in on this as “one hand washes the other”. Your increased medical costs mean you need medical insurance, which you have to buy from an insurance company. Which in turn skims its 15% to 20% off of what you pay in premiums (or your employer, or the taxpayers) so that you get only 80% to 85% back in the form of benefits. Nice deal they have going here! And to keep it going, the health industry spends ONE MILLION DOLLARS a year PER CONGRESS PERSON in the form of “lobbying” (bribes, pay offs, campaign donations, etc) to see that no one in Congress votes against the “interests” of the health industry! An “industry” that costs all of us almost TWO AND A HALF TRILLION DOLLARS A YEAR! That’s more than the entire federal government takes in in the form of revenue! Unbelievable, isn’t it? Rest of the developed world spends about half per capita on the average than we do here in the US. Which implies that at least a TRILLION DOLLARS a year is simply a “rip off”! Incredible, isn’t it!? If you do the study, the math, you can learn all this yourself. It took me YEARS, a lot of study, but I know the truth now. I know that Obama hasn’t “fixed” anything. As a matter of fact, he has made things WORSE than they were before when you consider “where” the money to pay for all this has to come from!

I wonder what Dr. Ron Paul would think of this discussion. In my experience, even the most libertarian minded doctors will very emotionally defend the AMA as being necessary, even if it IS a necessary evil. Again I don’t know Ron Paul’s opinion on this but I suspect he wouldn’t want to end medical licencing. I hope I am wrong on that because I like Ron Paul and wouldn’t mind him as president. Self interest has a way of making liars of us all. I have talked with libertarian lawyers who support deregulation of just about every industry, except for the legal industry. This seems to follow suite with most protected industries. It would be difficult to be an Agorist doctor. Not because of the threat of getting caught, but because you would also have to be an illegal pharmacist/chemist. How would your patient get their medicine? Agorist doctors would need a network of Agorist chemists and pharmacists as well as all the other support disciplines that make modern medicine possible. I think that the only model that might make way for this happening without outright smashing of the state would be the rise of independent resilient communities. Communities that would have the infrastructure to provide for their own needs. Needs such as agriculture, manufacturing, chemical and biotech, defense, and medicine would be provided by those in the community. If such a community also adopted Agorist philosophy then you would have something truly wonderful to behold. I actually think that this approach has a high likelihood of actually coming to pass. When you look at trends like DIY, 3d printers, Home manufacturing, garage chemistry and biotech, eating and shopping local, community agriculture and a surge in gun ownership, one can see the roots of such a movement in its infancy. Voluntary communities are, I believe the answer to the problem of The State and all of its cancerous monopolies.

The medical profession is well aware of how much their income depends upon maintaining a legal monopoly over the supply of medical drugs. The prescription laws serve as a barrier from allowing individuals to take care of their own health through medication without involving an MD in the process. Lawyers maintain the same monopoly enforced by the “State” in legal matters. By this means licensed professionals insure that no one can obtain health care, legal services, or whatever without having to pay a member of the profession his or her “fee”. This even applies to services from “vets” (animal doctors) in that you need a prescription to purchase heart worm pills for your dog or cat. In effect, almost any service you might wish to purchase now requires that you purchase this service from a “State Licensed” provider. This is usually done for “consumer protection” (or so the politicians will tell the public), but in many cases these laws are passed at the request of those who perform the service as it insures a better income for them at the expense of the consumer whose choices are thus limited. In a Libertarian society those who provide these services would be “certified” by a private non-governmental agency. But there would be no legal requirement that provision of these services would be limited to only those people who were “certified” to provide them. And as a general rule, the licensing process is much more restrictive than certification would be. Licensing pretty much exists as a means to restrict competition which in turn means that you have to pay more for the service than if there was a true competition between providers. In the case of doctors and lawyers, there appears to be some sort of “professional” agreement that no one will offer a lower price for their services than what is commonly agreed upon. This is one reason why the consumer is forced to pay so much for the service. Unlike when you want to buy say a digital camera you have a large choice of suppliers who offer competitive prices for the item. In effect when you deal with professionals it is much like dealing with the Department of Motor Vehicles, where the customer has no choice in the matter and must therefore put up with poor service and long waits… Proof if any is needed that the “State” exists not for the people, but only for those “special interest groups” that in reality are in control of things.

I agree with the overall notion that these regulations are unnecessary to a large extent. The goal should be to minimize the regulations to where they are actually necessary. I believe that those who argue for alternative medicine damage the case for medical freedom because the real problem isn’t that “traditional” medicine is somehow systematically flawed in a way that is harmful to patients, but rather, that the system has, for a long time, gone unquestioned by the public in the way that training and education has been accessed. There have been placed barriers to entry to the profession that are either circumstantially related to ensuring high standards of physicians, or are non sequitirs that upon careful examination and debate by an informed public will engender a great deal of cognitive dissonance.

Unfortunately, what needs to be recognized is that in refuting the claims of the present laws and authorities, one needs to provide the burden of proof simply because those who call for change are expected to do so by virtue of our political system and additionally as a result of human nature, which gives the benefit of the doubt to already established authorities.

It is not enough to simply argue that the other side’s arguments are untenable and ultimately harmful to our nation. This will create controversy, discomfort, and polarization, but unless the side that is on the side of individual liberty argues for an alternative that simultaneously addresses and convinces the majority that the law preserves genuine safety concerns and advances individual liberty, and not merely reject the former as an issue that the latter will naturally solve, it will not convince those who have not actually seen the beneficial effects of individual liberty and consumer choice to the extent that they will change their minds.

I think your position stems from a lack of honest consideration of the other side’s viewpoint. There are those who indeed manipulate presently existing laws to serve their own class interests or special interest, but the majority of people who defend presently existing licensing laws do so because they want to have the security in knowing that their and their children’s and families’ health and lives are in “good hands.” They have issues and complaints about the current system, but want to see alternative points of view that do not minimize or trivialize their concerns about the competence of physicians, but in actuality treats that concern as the end in itself, and questions of personal liberty in medicine as a means to that end. Treating personal liberty as the end in itself is a self-defeating political strategy because it leads to the unknown, and involves a suspension of disbelief in strict rationality in that it asks the listener to just believe that we know what’s best for society in the long run and that a free society will fix those problems naturally which is not at all unlike the argument posed by those in positions of entrenched authority who say that *they* are the ones who really know best and all of those regulations are only for the safety of the patient and in their best interest.

Even if individual liberty really does solve most problems that we have in society (and I believe it does), managing to convince the majority of people who are quite honestly fed up with all of the lies in the political system will require more effort on our part. In the end, if you can’t convince the other side to arrive at a compromise position that they feel preserves the core and spirit of what they rightly value (knowledge that our physicians are not incompetent), not merely because we wish to get a law passed, but because we are suggesting that some of the laws that are purportedly for the interest of the consumer are not in reality so, and further, and more importantly, that the laws that really do protect the patient are in practicality enforced by an organization that inherently has a conflict of interest, and the ultimate end of insuring patients’ concerns can be done so in such a way that any extraneous and superfluous regulations not directly pertaining to that end are actually hurting the patient and hence are contrary to the spirit of the law if it is intended to advance the patients’ safety. Confronted with such incisive reasoning on our part, the establishment can either admit that the laws aren’t really meant to protect patients and thus lose all credibility, or that they once were but now have been co-opted by special interests and are thus doing a disservice and hence concede that reform is not uncalled for.

Without a direct refutation and exposure of the inherent contradiction on the part of the medical establishment and the regulatory system, the authorities will always be able to fall back upon their “we know what’s best” paternalism. It’s simply the way it is. In an aristocratic or autocratic society, there is nothing the people can do save keeping our mouths closed and obeying the authority, or seeking revolutionary change, but in a system in which the democratic process exists, corruption and special interests need to be confronted in such a way that they lose whatever authority and credibility they claim to have, and establish by force of argument and intelligent discourse that our position, is in actuality the true authority. If we do this the right way, the other side’s position will reveal itself as fallacious, and the false authority will be revealed for what it is, and the beginning of our reform efforts will have a firm foundation.

From this point onward, if our take on the problem at hand and a suggested compromise solution that allows the effects of our proposed laws to be demonstrated (which I believe will succeed), then the goal is already half achieved, because the trust of the public has been earned. Attempting to bypass the democratic process stems, I believe, from not a greater wisdom but rather a shortsightedness that doesn’t see how to link small advances and changes to more significant long-term change, and also fails to select the best option among the many. I believe that there is almost always a solution to a problem that the democratic process, operating in its ideal, with earnest and farsighted leaders who serve and speak to the public disinterestedly can solve, and that if you’re resigned that anarchy is the only way out, that you’re just the opposite pole of those who seek to establish authoritarian control over issues and problems that they do not really understand, and do not wish to ultimately understand.

I’m a Republican who believes that issues such as health care reform can be solved by getting the right people contributing to the national debate, with new ideas and perspectives (such as yours and mine) being discussed, instead of the same old insurance industry reform perspective, so that genuine and insightful questions are brought forward to present leaders, and are answered before the people. What will also be important is making sure that reform efforts prove their viability and actual practical effectiveness starting at the local and municipal, then state level, prior to being enacted as federal policy, if that ever happens (which should rarely be the case); if a reform law isn’t even tested at a small-scale level, its failure at a large-scale level is certainly more likely, and what is worse, its performance cannot be evaluated and compared to other locations where the law has not been passed. The role of states and communities acting as “laboratories in democracy” is bypassed, and the only point of experimental comparison can be looking at the nation before the law was passed and after; however, this sort of comparison is more difficult to ascertain than being able to see the effects on two states simultaneously, with the law being the only distinction. Historical analysis and policy analysis is much harder to do and much more prone to bias than simple observation in the present.

Part of the problem is the assumption that the doctor knows “everything” and is “infallible” (like the Pope claims to be in matters of religion). My own experience has been that doctors do very well when dealing with issues which they have consideable experience with. Not as well with issues where they have little experience. I have experienced in my life two time where doctors made errors. The first time almost caused my death. The second time was fortunately mostly just a considerable waste of money. I suffer from ulcerative colitis. The medication used to treat this condition is “Sulfasalazine”. Fortunately it is not very expensive as the other medicine used for this diseases is a “non-perferred brand name” that insurance companies don’t like paying for. However, like all medicine, sulfasalazine has “side effects”. One of these side effects (which effect just a relatively few people) is reduction of your red cell blood count. When this condition was noted in my blood tests, both my primary care physician and the specialist (gastroenterologist) started running tests. The specialist also did a complete check of my insides from both ends. Fortunately my insurance paid for most of this as the bill was as expected rather considerable. However these tests didn’t really find the cause so the next step they wanted to do was to send me to a cancer specialist for a complete workup. (also rather expensive). However, I went on the Internet to the Mayo website, checked for the medication I’m taking as to side effects. One of the less common side effects of this medicine is reduction of red cell count. Now these were two experienced doctors, one a specialist, who both knew what medicine I was on. But neither of them bothered to do what I did. This is why I do not have a lot of trust with the medical profession. And why we should not see doctors as infallible or knowing everything. They are neither. Yes, they go to medical school, learn a lot, but how much do they remember what they learned a couple of decades later on? How much does anything reading this remember of their own education? Most of us do remember something, but just a fraction of what we once knew. Doctors have the same problem. Plus in many cases they are very “busy” and don’t have the time to do the necessary research to find out the truth. This is I think a consideration when we wish to give the medical profession so much power over our lives. They do make mistakes. I survived mine. Someone else might not have been so lucky…

I’m a recently graduated doctor, who also recently immigrated to the US. I am going through the ridiculous US medical licensing process (which is even more ridiculous, expensive and time-consuming if you graduated abroad). I’m hardcore libertarian, and support all that has been said in this thread. I don’t think I would loose income if my state supported monopolium over the health business was ended. I would greatly enjoy the increased competition, and also would have a lot more of opportunities to make money without regulatory hassles. I would be even able to toss away the requirements of completing a residency (which I will begin this year), learn on my own, hire an excellent senior doctor to teach me the practical skills which I could not learn on my own, and set my own practice. What do you guys think is the prospect of liberty in the next decades?